128. Light Periods Explained: What Your Hormones Are Trying to Tell You

A super light 1–2 day period can feel like a win—but sometimes it’s your body’s way of saying your uterine lining isn’t getting the estrogen and progesterone support it needs. In this episode, Dr. Monica Minjeur explains what light flow can mean, how endometrial thickness and pattern reflect hormone health, and when it’s time to check cycle-timed labs and an ultrasound—especially if you’re trying to conceive.

You’ll hear Nina’s story: an endurance runner in graduate school with a suddenly lighter period, low iron stores, low-normal estrogen, borderline progesterone, and a thin uterine wall lining. With targeted nutrition, reduced training load, iron repletion, and luteal phase progesterone support, her fertile signs improved, her bleeding normalized, and she felt confident about her fertility plan.

If you want a clear, cycle-informed evaluation and a personalized plan, book a free discovery call at radiantclinic.com (click Book Free Discovery Call). We offer in-person care in Cedar Rapids, Iowa, and telehealth across many states.

Transcript

Speaker: 0:01

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. A super light one or two day period might feel lucky to you, but is your endometrial lining getting what it actually needs? In this episode, I'm going to break down what a light flow with your cycle really means. How estrogen and progesterone both help to shape the endometrium or uterine wall lining when it's important to check labs and ultrasounds, and practical changes that can build a healthier amount of bleeding, not only for comfort, but to improve your health and promote fertility. So let's start off as always with a story about a patient of mine who we'll call Nina. When Nina first came to see me, she was an avid long distance runner and she was in her first year of graduate school. She had recently been married and they were hoping to start trying to conceive within the first year. However Nina was concerned, she knew that her very light periods of only lasting one or two days were potentially a sign that her body wasn't ready for pregnancy. After the third cycle of seeing this, she came to seek further evaluation from our clinic because she was really concerned that this was not going to lead to pregnancy, and it was a significant shift from what she had been noticing previously. Now luckily for us, Nina was already charting her cycles and when she came to us for her chart review, we noticed cycles were anywhere from 28 to 35 days apart, which is normal. However, she only had one or two days of a light flow. She also was having a hard time identifying any fertile mucus or an ovulation window, and occasionally when she went on longer runs, she would notice that she had some mid cycle bleeding. Now again, at this time, Nina was running quite a lot, roughly 40 or more miles per week, and she had noted that during graduate school she was getting a little less sleep than usual, averaging about six to seven hours a night, and had been utilizing quite a bit of caffeine in order to be functional during the day. Our initial workup with Nina showed that her uterine wall lining was a bit thin. It was 5.2 millimeters. Labs revealed that her estrogen levels were on the low side of normal, and her progesterone levels were also borderline. She had low iron stores and the rest of her labs were fairly normal, including her thyroid and prolactin. Okay. We talked with Nina about how she could help to balance her hormones in a couple of different ways, and one of those ways was talking through how to balance her exercise, her dietary intake, and her stress levels. Now it's really challenging in some cases to understand that too much exercise can actually cause problems from a hormone standpoint. So we worked on slowly scaling, Nina's running back. She worked towards getting more protein with her meals as well as repleting some of her iron stores and other labs that were a bit on the low side. Over the course of the next three months, we also added in some luteal phase progesterone support, and we found that she had a much more clear ovulatory pattern with fertile mucus improvements, and her periods began to lengthen back out to a normal three to four days of healthy flow. By the time that she left our care, Nina said that she felt confident that she was able to identify not only when she could get pregnant, but also felt better about knowing that her body was more prepared now that she was back to her regular cycles. Now, most of the time women don't come in complaining of having a light period. In fact, many women would prefer to have a very light period, and this can be normal for some women. However, persistent, very light or very short menstrual flow can oftentimes be a reflection of an endometrial lining or a uterine wall lining. That is quite deficient in estrogen. So in plain English, estrogen is important for helping to increase the endometrial lining and it increases blood flow to the area. This is what sets up that lining thickness and just a nice healthy pattern to allow implantation to occur later on during your cycle if you were to become pregnant Progesterone, which again, typically is going to show up. After ovulation will help convert that lining of the uterus into one that is more receptive for implantation to occur. If either of these steps are suboptimal, either estrogen or progesterone, the total amount of tissue that is shed and blood during your menstrual cycle is going to be shorter and lighter. Now this matters not only for fertility, but it also makes a difference in your menstrual cycles. Again, if your estrogen is low or your progesterone are low, you are more likely to have other symptoms. So with fertility, obviously this makes a big difference because the lining quality, not just the thickness, will both influence your body's ability for implantation to occur. Again, if we have suboptimal estrogen, oftentimes that will run hand in hand with other things like a later ovulation, impaired fertile mucus, or inability to even identify that ovulation is happening in an optimal way. If you have suboptimal progesterone, as we discussed in last week's episode, it can lead to shorter luteal phases or abnormal bleeding that happens before an astral menstrual cycle. And again, anytime that your hormones are not balanced, especially estrogen and progesterone, we're going to have more troubles as far as fertility in the first place, but also have an increased miscarriage risk if these things are not corrected. So how do we look at this in the context of a restorative reproductive medicine approach? Our first step is always going to be that evaluation of your charting. We're looking for symptoms that you have, looking at the flow, the strength of your cycle, presence of clots or spotting that's happening either before or after your period actually begins. We also want to be recording if you are. Understanding when that ovulation window is happening and if you are seeing clear signs that you have actually ovulated. It's also really important for people to track other things that may be impacting this. So for example, in Nina's case, how much she was exercising, was she doing any fasting? What was her sleep pattern like, and was she having any stress situations? All of these markers can help us to identify when there may be something else playing a role. With those shortened cycles. So after we've been able to evaluate what's happening with your charting next, it's important to get some timed labs drawn. Again, ideally, when we're looking at these shorter, lighter cycles, it's really crucial to look at what's happening in about the week that's leading up to that menstrual cycle beginning. So ideally, we like to aim for one week. After ovulation, but if that's not super obvious, we try and estimate a few days prior to when your next menstrual cycle will begin. So again, specifically looking for estradiol and progesterone levels. We also want to look at ferritin, which is your iron stores, as well as a complete blood count and consideration of other vitamin levels that may be playing a role with fatigue, hair troubles. Energy loss or other things that may show that you are deficient in particular vitamins. We always will also look at a full thyroid panel, including antibodies, especially if you are having other thyroid related symptoms. We know that thyroid is one of the main hormones that can go sideways and hijack all of the other hormones, and so it's important to understand that if we have hormone levels that are inadequate, then we understand why they're going off. Then we'll also always evaluate or consider doing an ultrasound. Again, it's important to understand the thickness of that endometrial wall or the uterine wall lining. It's important to look at the pattern, and usually we see what we call a trilaminar appearance, which means it looks like there's three separate layers to the inside lining of the uterus, and this tells us that it is healthy. We also will look at timing of when we look for that ultrasound. Again, earlier on in your cycle, it's going to be a bit thinner, whereas after ovulation, it typically is going to be a bit thicker in preparation for possible implantation. Now as we go through all of this evaluation, we always want to keep in mind what are some of the other reasons why we can have troubles. One of those main reasons can be hypothalamic amenorrhea, and again, this is more about under fueling your body or over exercising or stress. For more information about hypothalamic a amenorrhea, go back and check out episode number 86 where I do a deep dive talking about what happens if you are exercising too much or not eating enough to keep up with that. Another thing that can cause these light cycles is as you are transitioning off of oral birth control pills, now it can sometimes take three to six months for your body to recalibrate and get back on track. But you can still monitor your cycles and what's going on during this time to understand if things are moving in the right direction. If you are still having very light periods after six months off the pill, it's important to see and check if your estrogen levels have restored enough or if you may need some additional assistance with this. Okay. Again, we're also always looking for other causes like thyroid dysfunction, low iron stores, low blood counts, anything else that might be delaying or decreasing the amount of bleeding your body is able to have. And then finally, with that ultrasound, we're always checking for if you have. Other endometrial factors, they're playing a role. So things like fibroids or polyps can rarely cause issues. As far as those lighter cycles, they typically will cause heavier bleeding, but again, depending upon their location and depending upon what else might be going on with them, we want to make sure to rule out any of these other unusual factors. So what do we do to treat these light cycles and how do we get back on track Again, always focusing on what the underlying cause is. So if we find that you have issues as far as low estrogen or low progesterone, we want to support those hormone levels wherever possible. If needed, we can utilize bioidentical hormone replacement therapy to help improve those levels temporarily. But again, always looking at what is the long-term plan for getting these things back on track naturally. So first and foremost, as was Nina's case, making sure that you have enough fuel to keep your body going, focusing especially on a protein forward breakfast. Ideally, we talk about at least 25 to 30 grams for breakfast with protein. Talking also about making sure that we get enough protein distributed throughout the day, and if you are doing any sort of longer distance endurance training to make sure that you are getting plenty of carbohydrates or those healthy starches around the time of your workout. Sometimes before, sometimes during, sometimes after, to make sure that your body has enough of that rapid acting fuel so that it decides not to start turning off what's happening from your hormone standpoint. If you are somebody who is excessively exercising or who exercises quite a lot, we want to aim for reducing the volume of that high intensity cardio. Try instead to focus on a couple of shorter resistance sessions. During the week and aiming for not having a heart rate higher than 150 for more than 15 minutes at a time can also help you to restore a better balance when it comes to your hormones. Now, I am not saying that you should not be exercising as exercise is very healthy for lots of other reasons, but when it comes to your hormones, and if we find that you have irregularly short cycles. Shorter days of bleeding, shortened luteal phases, all of those can be signs that your body is not functioning well with those hormone levels, or in some cases, that you are actually in danger of seeing your cycles disappear altogether. And finally, and most importantly, as we go through this process of restoring your hormones, of improving the lifestyle balance, of improving what's happening from your overall standpoint of what we see with your menstrual cycles, we want to repeat testing, checking your labs again, seven days after ovulation to make sure that estrogen and progesterone are actually improving. Repeating an ultrasound if needed, to confirm that the lining of your uterus has. Gotten more thick that it's following appropriately with what we would expect to see for the cycle time that you are at, and if you are still not noticing any significant improvements. Then we need to reassess and redefine further what are the next steps? All of these things can be corrected, and again, for many women, it's hard to say. I don't wanna have a one or two day cycle. That is the dream for most people. But again, we want to identify and recognize that this can be a problem. So I just wanna wrap up today with a couple of quick questions that we get oftentimes asked. When it comes to evaluating these lighter cycles. I oftentimes will get asked, well, what is the optimal thickness that my uterine wall lining should be? And for most natural cycles, most of us in the field of restorative reproductive medicine. Are happy when you've got at least a seven or eight millimeter endometrial lining. And again, we want to see that trilaminar pattern, meaning we've got three different appearances of the layers in order to say that we've got good quality, good thickness. Now, some women can conceive at slightly thinner measurements if the pattern and the hormones are appropriate, but really that seven to eight millimeters or more is kind of our sweet spot. Another big question we oftentimes get asked is, should I take estrogen? And while we absolutely will focus on treating the root cause of why your estrogen is low in the first place, so we want to address things like, am I getting enough caloric intake? Are my iron stores appropriate? Am I sleeping well? Are my ovaries functioning appropriately? If we have identified that all of those root causes are doing well and we are still struggling, then we absolutely will recommend utilization of estrogen in cases where we need to help build up that lining and get your cycles back on track Again, always wanting to use the lowest dose possible for the shortest amount of time, and incredibly important to make sure that we are continuing to evaluate and utilize bioidentical hormone replacement therapy. Whenever possible, imagine if your period lengthened from a quick one or two day bleed to a more healthy and confident flow because your endometrium finally received the fuel, sleep, nutrients, and hormone support that it needed. Over the course of just a few months, your cycles and your menstrual bleed can be more consistent. And these changes ultimately lead to overall improved health and promoting fertility.

Speaker 2: 16:29

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.